Fillable Employers Name Occupation Employers Address Phone E-Mail Address (Borough of Wilkinsburg)

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Employers Name Occupation Employers Address Phone E-Mail Address (Borough of Wilkinsburg)

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BROWSE BOROUGH OF WILKINSBURG (PA) FORMS

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Wilkinsburg Borough
Authorities, Boards and Commission Interest Form
Are you a registered Voter in Wilkinsburg? YES NO
How long have you resided in Wilkinsburg? Years
How many Wilkinsburg Borough Council meetings have you attended in the past three years?
EDUCATIONAL BACKGROUND
High School Attended:
University / College attended:
Degrees received:
REFERENCES (List two)
Name: Phone number:
Name: Phone number:
PLEASE ATTACH A COPY OF YOUR CURRENT RESUME
Authority(ies), Board(s) or Commission(s) preference (Please indicate from 1 to 3 with one being your first choice):
LIBRARY BOARD* _____
SHADE TREE COMMISSION* _____
PARKS AND RECREATION ADVISORY BOARD* _____
COMMERCIAL & INDUSTRIAL DEVELOPMENT AUTHORITY*
NOTE: IT IS THE PREFERENCE OF THE BOROUGH OF WILKINSBURG THAT APPLICANTS ATTEND AT LEAST
ONE MEETING OF THE BOARD TO WHICH THEY ARE SEEKING APPOINTMENT.
*Residency Requirement **Must be a registered elector in Wilkinsburg Borough
WILKINSBURG ARTS ADVISORY BOARD
WILKINSBURG PENN JOINT WATER AUTHORITY BOARD*
REDEVELOPMENT AUTHORITY*
PLANNING COMMISSION*
ZONING HEARING BOARD*
MUNCIPAL AUTHORITY*
CI
VIL SERVICE COMMISSION**
SPECIAL EVENTS COMMITTEE
PENSION BOARD _____
SOCIAL MEDIA COMMITTEE
Name
Home Address City ______________ State Zip ________
Employer’s Name Occupation
Employer’s Address
Phone E-Mail Address
_______________
_______________________________
Months
Major area of study:
____
_______
__
____
BRIEFLY DESCRIBE WHY YOU WISH TO SERVE AS A MEMBER OF EACH BOARD OR COMMISSION AND HOW
YOUR PERSONAL EXPERIENCE AND BACKGROUND RELATE TO THE FUNCTION OF EACH BOARD OR
COMMISSION ON WHICH YOU WISH TO SERVE
INTERESTS/HOBBIES:
LIST COMMUNITY/CIVIC INVOLVEMENT:
Membership on the Zoning Hearing Board requires compliance with Pennsylvania law regarding the filing of
financial disclosure forms with the State Ethics Commission annually.
The Borough Council may conduct interviews at the time a vacancy on an authority, board or commission
occurs. Appointments are then made at legislative Council meeting.
Applications will be kept on file in the Community Leadership Resource Bank (CLRB) maintained in the Borough
Secretary’s Office for Two Years. Applicants will be notified of vacancies prior to the scheduled interview.
As an applicant for appointment, this information is covered under the Pennsylvania Open Records Law and
therefore may be made available to the press and the public. The Borough of Wilkinsburg exercises affirmative
action in its appointment practices.
Signature of Applicant:________________________________________________________________
Date
Please return the completed form to:
Wilkinsburg Borough Manager’s Office
605 Ross Street
Pittsburgh, PA 15221
412-244-2905
For Office Use Only.
Date application received:____________________ Board/Commission vacancy:________________
Date Interviewed:____________ Appointed : Y_____ N______ Date:_____________
FAX: 412-244- 8642
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Employers Name Occupation Employers Address Phone E-Mail Address (Borough of Wilkinsburg)

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Completed 17 July 2020

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